Denials Management Specialist

Reviews claim denials related to medical necessity, pre-certification, authorization, and level of care requirements. Works closely with internal departments and insurance companies/payers to resolve denied claims.

Requirements

• Reviews and resolves denied patient insurance claims
• Works closely with internal departments in determining accurate denial and process for appeal
• Contacts insurance companies/payer or patients to gather information necessary to complete the appeal process
• Sends appeals to insurance companies regarding denials
• Provides process improvement recommendations to Supervisor to decrease future denials
• Utilizes software tools to identify denial, trends and payer issues
• Shares findings with stakeholders
• Follows up on pending claim denials after appeal has been processed -by the insurance company
• Collaborates in the collection of data and sends monthly “Managed Care Denial Report” to appropriate department Leaders

Benefits

• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, and Vision options
• Tuition Reimbursement
• Free Parking at designated locations
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities